Effects of Task-Specific Locomotor Effects of Task-Specific Locomotor and Strength Training in Adults Who and Strength Training in Adults Who Were Ambulatory After Stroke: ResulWere Ambulatory After Stroke: Results of the STEPS Randomized Clinical ts of the STEPS Randomized Clinical TrialTrial

Background and Purpose

A phase II, single-blinded, randomized clinical trial was conducted to determine the effects of combined task-specific and lower-extremity (LE) strength training to improve walking ability after stroke.

Subjects

The participants were 80 adults who were ambulatory 4 months to 5 years after a

unilateral stroke.

Method

Eligibility criteriaEligibility criteria age 18 years or older 4 months to 5 years after first-time onset of

a ischemic or hemorrhagic CVA able to ambulate at least 14m with an

assistive or orthotic device assistance of one person

voluntarily provided informed consent approval of their primary care physician to

participate

Exclusion criteria

Health conditions

recent exercise study participation

Serious medical conditions

Exercise sessions were 4 times per week for 6 weeks

Outcomes were self-selected walking speed, fast walking speed, and 6-minute walk distance measured before and after intervention and at a 6-month follow-up.

BWSTT：body-weight-supported treadmill training

CYCLE： limb-loaded resistive leg cycling LE-EX： LE muscle-specific progressive-resistive exerciseUE-EX： upper-extremity ergometry

BWSTT / UE-EX

CYCLE / UE-EX

BWSTT / CYCLE

BWSTT / LE-EX

Strcjke severityBWSTT

＆ UE-EX

CYCLE＆UE-EX

BWSTT＆CYCLE

BWSTT＆

LE-EX

LE-FM motor score

(maximum score=34)

24.5 (5.5)

24.4 (4.5)

24.2 (4.0)

22.1 (6.3)

Berg Balance Scale

(maximum score=56)

42.1 (9.8)

42.6(11.4)

45.2(10.1)

40.4 (15.0)

Primary and outcomes at

baseline

BWSTT＆

UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Comfortable gait speed

(m/s)

0.49 (0.24)

0.48 (0.28)

0.53 (0.28)

0.52 (0.35)

Fast gait speed (m/s)

0.69 (0.38)

0.65 (0.42)

0.71 (0.38)

0.76 (0.50)

6-min walk distance (m)

189.3 (99.9)

170.0(115.2)

187.6(99.9)

190.0(135.4)

After 24 Treatment Sessions

BWSTT＆

UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Baseline0.50

(0.23)0.43

(0.25)0.54

(0.28)0.57

(0.35)

Pusiintervention 0.63 (0.32)

0.44 (0.26)

0.63(0.33)

0.67(0.37)

Change0.13

(0.14)0.01

(0.07)0.09

(0.12)0.10

(0.07)

10-m Comfortable gait speed(m/s)

10-m fast gait speed (m/s)

BWSTT＆

UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Baseline 0.71 (0.37)

0.57(0.36)

0.73 (0.39)

0.80(0.51)

Pusiintervention 0.81 (0.43)

0.58 (0.39)

0.81 (0.44)

0.90(0.51)

Change0.10

(0.14)0.01

(0.09)0.08

(0.13)0.10

(0.08)

6-min walk distance (m)

BWSTT＆

UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Baseline 196.96 (96.4)

149.00(99.6)

192.33(102.3)

199.28(137.87)

Pusiintervention219.46(106.0)

164.52(118.6)

217.79(122.6)

244.60(144.57)

Change22.5

(34.8)15.5

(31.0)25.5

(37.6)45.3

(33.5)

6-Month Follow-up

BWSTT＆

UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Post-session 24 0.63 (0.32)

0.44 (0.26)

0.63(0.33)

0.67(0.37)

6-mo foliow-up 0.65 (0.33)

0.43 (0.26)

0.64 (0.32)

0.77 (0.03)

Change0.02

(0.11)-0.01 (0.11)

0.01 (0.10)

0.05 (0.09)

10-m Comfortable gait speed(m/s)

10-m fast gait speed (m/s)

BWSTT＆

UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Post-session 24 0.81 (0.43)

0.58 (0.39)

0.81 (0.44)

0.90(0.51)

6-mo foliow-up 0.82 (0.44)

0.60 (0.42)

0.83 (0.43)

0.94 (0.69)

Change 0.01 (0.10)

-0.01(0.17)

0.02(0.12)

-0.04 (0.37)

6-min walk distance (m)BWSTT

＆ UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Post-session 24219.46(106.0)

164.52(118.6)

217.79(122.6)

244.60(144.57)

6-mo foliow-up219.50(116.85

)

165.54(116.13

)

233.61(131.31)

266.40(133.03)

Change0.04

(55.54)-4.98

(55.40)12.03

(24.70)0.71

(32.64)

Results

Discussion and Conclusion

BWSTT/UE-EX V.S

CYCLE/UE-EX

BWSTT＆

UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Post-session 24 0.63 (0.32)

0.44 (0.26)

0.63(0.33)

0.67(0.37)

6-mo foliow-up 0.65 (0.33)

0.43 (0.26)

0.64 (0.32)

0.77 (0.03)

Change0.02

(0.11)-0.01 (0.11)

0.01 (0.10)

0.05 (0.09)

10-m Comfortable gait speed(m/s)

10-m fast gait speed (m/s)

BWSTT＆

UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Post-session 24 0.81 (0.43)

0.58 (0.39)

0.81 (0.44)

0.90(0.51)

6-mo foliow-up 0.82 (0.44)

0.60 (0.42)

0.83 (0.43)

0.94 (0.69)

Change 0.01 (0.10)

-0.01(0.17)

0.02(0.12)

-0.04 (0.37)

6-min walk distance (m)BWSTT

＆ UE-EX

CYCLE＆UE-EX

BWSTT ＆CYCLE

BWSTT＆

LE-EX

Post-session 24219.46(106.0)

164.52(118.6)

217.79(122.6)

244.60(144.57)

6-mo foliow-up219.50(116.85

)

165.54(116.13

)

233.61(131.31)

266.40(133.03)

Change0.04

(55.54)-4.98

(55.40)12.03

(24.70)0.71

(32.64)